by jwilli


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Note:  What is the daily volume requirement equation..this was an older one in renal block but is necessary in our calculations?
1500 ml for first 20 kg of body weight.
20ml/kg for every kg > 20 kg
What is ASPEN?
A nutritional assessment which provides a comprehensive approach to defining nutritional status: Incorportes:
1) Medical
2) Nutrition
3) Medication histories
4) Physical examination
5) anthropometric measurements
6) Laboratory data
Is nutrition screening mandatory in hospitals?
Yes
What is the time frame in which hospitals must do their nutritional screening?
within 24 hours of patient admitance
What does the assessment do?
Determines if patient is malnourished or at risk for malnutrition.  Assesses the route and need for treatment
What specific parameters indicate if a patient is at risk for malnourishment?
1) Patient has lost > 10% of body weight in the last 6 months
2) Patient has lost > 5% of body weight in the last month
3) Patient is more 20% over or under ideal body weight

***Know these in terms of actual numbers***
What is the number 1 thing we think is the problem if a patient has more than 10% weight loss during the past six months?
Cancer.
How do we assess inadequate nutrition intake?
1) If the patient isn't receiving any nutrition
2) Impaired ability to ingest or absorb food for more than 7 days
What weights do we use when making calculations?
Patient with BMI > 30 use Adjusted Body Weight

Patient with BMI < 30 use actual body weight
How do you calculate BMI?
(lbs x 703)/(inches)2

or

kg/m2
How do you calculate ABW?(adjusted body weight)
ABW = IBW + 0.4(AW-IBW)
What is BIA..think about electricity flowing through the body of a muscular person vs. a fat person..what are the differences?
Electricity flows through the body of a fat person slower than a muscular person
Physical Exam should involve this?
The entire body of a person..eyes, ear, skin and nails, cardiovascular,...everything!!
Why is Nitrogen assessment so important?
Nitrogen is a breakdown product of Protein.  If the nitrogen measurement is too low then its possible that
How much Nitrogen is in protein?
1 gram of Nitrogen is in 6.25 grams of protein
What is the goal of Nitrogen we want to have in the urine?
+2 to + 4 grams per day (24 hrs)
Between Albumin, Transferin, and Prealbumin which is best to measure for nutritional assessment?
1) PreAlbumin (half life 2-3 days)
2) Tranferin (1/2 life..8-9 days)
3) Albumin (18-20 days)
If you want to see if a person is gaining weight, what will you look for?
PreAlbumin..you want to see it going up
What is BEE?
Basal Energy Expendiature.  This is the amount of energy that a person will need in the resting state, just to keep vital organs functioning after waking and after a 12 hour rest
What is TEE?
Total Energy Expendiature.  The total amount of energy a person will expend throughout the day including the BEE and everything that a person does
What is the most common equation used to measure the body energy requirements?
Harris-Benedict equation.
Harris-Benedict equation measures this?
BEE only.  Harris Benedict equation does not measure the TEE
What is the Harris Benedict equation for men?
66+13.75(wt.kg) + 5(ht cm) - 6.8 (age)
What is the limitation of the Harris Benedict equation?
It doesn't represent the current patient population
What is the equation for women?
655 + 9.6(wt kg) + 1.8(ht cm) - 4.7 (age)
What is the TEE  equation?
TEE (Kcal/day) = BEE x (Stress factor + Activity factor)
What are the typical stress + activity factors in the TEE
1.2 to 2
What are the ASPEN recommendations for the amount of kcal/kg/day you should have?
Nonstressed:  20-25 kcal/kg/day

Trauma/Stress/Surgery: 25-30 kcal/kg

Repletion: 25-35 kcal/kg/day
What three types of nutrients do we give patients?
Dextrose (Carbohydrate source)
Fat
Protein
Of the three things that we don't include into the final calculation of daily needed calories?
Protein. We will subtract the protein out of the result from the patient
What factor do we use for glucose and dextrose?
Multiply 3.4 (For IV)
Multiply 4.0 (Raw..eat)
What is the factor for EtOH?
Multiply by 7
What is the factor we multiply by for Fat?
Multiply by 9
What factor do we multiply by for Protein?
Multiply Protein by 4
Put it all together...what are the factors we use for
1) Glucose/Dextrose
2) EtOH
3) Fat
4) Protein
1) Glucose/Dextrose = 3.4
2) EtOH = 7
3) Fat = 9
4) Protein = 4
The upper limit of Glucose is limited by?
Insulin production or administration
What are the essential fatty acids?
Omega-6 and Omega-3 fatty acid
What signs of Essential Fatty Acid (Omega-6 and Omega-3) deficiency?
Dermatitis, Alopecia, impaired wound healing, growth failure, thrombocytopenia, anemia
What is protein limited by?
Comorbidity of renal infection.  You will see protein spilling
What are two situations limited by protein-calorie malnutrition?
Marasmus
Kwaskiorkor
Mixed Marasmus/Kwashiorkor
What is Marasmus?
A chronic condition (i.e. cancer) leading to inadequate intake or use of protein and calories
What types of tissue wasting occurs in Marasmus and what is preserved?
Somatic protein and adipose tissue wasting occurs, but visceral protein (albumin and transferrin) is preserved
What is Kwaskiorkior?
Condition in which there is adequate intake of calories but inadequate intake of protein
What is depleted in kwaskiorkor, and what does this depletion lead to?
Depletion of visceral protein stores leading to hypoalbuminemia and edema
What is mixed Marasmus/Kwaskiorkor?
Starved patients during periods of hypermetabolic stress
What are the estimated protein requirements for
What are the estimated protein requirements for Maintenance?
0.8 - 1.0 g/kg/day
What are the estimated protein requirements for Mild to moderate stress?
1.0-1.5 g/kg/day
What are the estimated protein requirements for Moderate to severe stress?
1.5-2.0 g/kg/day
What are the estimated protein requirements for Severe obesity (use IBW)?
2.0g/kg/day
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